BackgroundChikungunya fever is a disabling articular disease caused by chikungunya virus (CHIKV). In the past decade it has affected millions of people across America, Africa, Asia, and Europe, turning this infection into a public health concern. The acute phase of chikungunya infection is usually self-limiting, characterized by severe arthralgia, fever, chills, myalgia, headache, and rash. CHIKV neurovirulence is evident and seems to be higher among elders. Considering their susceptibility to cognitive decline and dementia, the aim of our study was to investigate whether CHIKV infection might cause long-term cognitive impairment in aged people.MethodsA cross-sectional study was conducted with volunteers aged from 60 to 90 who had been affected by chikungunya and also with healthy controls. A structured questionnaire was used to record demographic and clinical data, functional status, and depression. Global cognitive function was assessed through MoCA. A comprehensive neuropsychological battery was performed to assess specific cognitive functions.ResultsSubjective memory complaints were present in 70% of subjects with previous chikungunya. This group had a poorer performance in MoCA (p = 0.000) and specific cognitive tests: Semantic (p = 0.05) and Phonemic Verbal Fluency (p = 0.003), 5-Digit (choice, reading, counting and alternance, p = 0.003, p = 0.014, p = 0.021, and p = 0.021, respectively), Stroop test (time, errors and interference, p = 0.000, p = 0.027 and p = 0.015, respectively), and RAVLT (word total session p = 0.05). These tests reflect performance on general executive functions, cognitive flexibility, inhibitory control, processing speed, semantic memory and episodic memory.ConclusionOur data suggest that CHIKV infection may cause long-term cognitive decline in aged people and might be a risk factor for future dementia in this population.
Electrical injury (EI) is the sequel of an electrical shock. Physical sequelae are most common, but also other symptoms can happen, such as neurological symptoms, psychiatric alteration, and cognitive decline. The repercussion of EI can happen whether or not the head is a point of contact with the electrical current. There are no official diagnostic criteria for cognitive repercussions of EI, which may lead to incorrect diagnostics and confusion with other most frequent causes of dementia, such as frontotemporal dementia, pseudodementia, or dementias for reversible causes. In this case report, we described a right-handed man, aged 56 years old, referred to our service due to behavioral changes and cognitive alterations related to electric shock. The psychiatric team has monitored him, but cognitive deficits have raised doubts about the presence of dementia syndrome. The neuropsychological evaluation revealed severe deficits and loss of functionality, which filled the criteria for major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). Adding these findings to the patient's history and after a detailed investigation of other causes of dementia, we concluded that this is a possible case of EI with strong neuropsychological symptoms. This case report should help clinicians to recognize this condition and its features. We aimed to share the importance of recognizing the neuropsychological and psychiatric features of EI, mainly in the Brazilian context.
ABSTRACT. Verbal fluency tests are common instruments used in neuropsychological evaluation and screening for cognitive decline. Different studies have suggested normative data for these tests, but new studies that focus on different educational backgrounds are important due to the heterogeneity of the Brazilian population and the influence of educational level on verbal fluency tests. Objective: The present study aimed to provide normative data on verbal fluency tests for highly educated older adults in Brazil, as well as the influence of sex, age, and education on test performance. Methods: A total of 147 healthy volunteers (106 females and 41 males) with a mean age of 66.87 years (SD=4.52) and a minimum of 12 years of education were selected from the community and asked to perform three tests of phonemic verbal fluency (letters F, A, and S) and two tests of semantic verbal fluency (animals and fruits). Volunteers were categorized by educational level into two categories: “High School” (12 years of formal education) and “Higher Education” (over 12 years of formal education). Results: Normative data are presented in mean values and percentiles for all tests. The performance in animals, fruits, A, and S were associated with educational background. The performance in S was associated with sex. Conclusions: This study provides normative data appropriate for highly educated, healthy older adults in commonly used tests that evaluate executive functioning. The results endorse previous study findings on the influence of educational level on verbal fluency tests.
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